Competitive bodybuilder and exercise science expert Dr. Mike Israetel believes testosterone replacement therapy (TRT) can be life-changing for men struggling with low testosterone, but insists that lifestyle improvements should come before hormonal intervention.
Speaking on The Iced Coffee Hour podcast, Israetel offered a detailed breakdown of when TRT becomes appropriate, the benefits men can experience after starting treatment, and some of the potential downsides that come with elevated testosterone levels.
When asked whether most men over 40 should be on TRT, Israetel offered a qualified no, although he suggested the answer might not be too far from yes.
“I would say if you’re over 40, making sure to get your lifestyle boxes checked, that you’re doing exercise, good nutrition, good stress management, good sleep, and then getting your testosterone checked to see what range it’s in after you’ve inculcated all those good good habits,” Israetel explained.
The bodybuilder stressed that poor lifestyle habits can contribute to low testosterone, making it important to address those factors before considering treatment.
“If your sleep is off or if you drink a bunch your testosterone is going to be low. And TRT is not going to really help you much cuz it’s just going to be like, ‘Hey, your life sucks. Let’s spray testosterone on it,'” he said.
According to Israetel, TRT becomes a considerably more compelling option when someone continues to experience low testosterone despite making meaningful lifestyle improvements.
“If you do have low testosterone after accounting for all those factors then TRT can be an unbelievable life-changing thing and I’ve seen it change very many men’s lives for the insanely positive rapidly, specifically in late 30s early 40s individuals,” he stated.
He clarified that this does not mean every man entering his 40s should automatically consider testosterone therapy.
“So I can’t say like most people should be on TRT in their 40s but if you qualify because you have lower than average testosterone and it’s affecting your life in a negative way, then TRT is like a miraculous amazing thing,” Israetel noted.
Israetel also explained what men with genuinely low testosterone might notice after beginning treatment, highlighting changes in confidence, energy, recovery, and motivation.
“One thing they would notice is a higher degree of confidence. You just like say stuff to people and just watch them react. You just don’t care as much anymore,” he said.
He also pointed to improvements in daily energy and workout recovery.
“Another one is that you’ll have more sustained daily energy. You just kind of feel more oomph. You’re going to be recovering from workouts in a way you didn’t think was possible since your early 20s. Like you train, you get sore, you heal, you’re like, ‘Oh, my joints feel fine. I guess it’s time to go train hard again,'” Israetel continued.
The bodybuilder added that treatment can also improve a person’s overall outlook.
“Overall motivation and drive, the zest for life can go up.”
However, Israetel cautioned that increased testosterone can also come with undesirable behavioral changes, particularly when it comes to aggression and libido.
“Your probability of becoming recalcitrant during confrontations also goes up. So you got to watch your temper a little bit,” he warned.
He also described how increased testosterone could influence sexual desire.
“Potentially your intimacy drive can go up in a way that’s sort of experienced as like a hunger. Stuff like you see a hot girl if you have normal low testosterone let’s say and you’re like, ‘Ah she looks nice I guess.’ You see a hot girl if you’re on plenty of testosterone and you’re like ‘Whoa.'”
Israetel acknowledged that this could become frustrating for men in relationships.
“If you’re in a relationship and you see hot girls all the time that’s annoying because you’re like why am I thinking about this all the time this is ridiculous.”
Sleep disruption is another potential concern, particularly when TRT is dosed too aggressively.
“Sometimes people on TRT when it’s dosed a little high can experience some like degradation of sleep quantity cuz they’re kind of like jazzed up a lot and they just don’t feel like sleeping and that can have like not so great effects,” he explained.
Ultimately, Israetel’s argument is that TRT should be approached as a medical treatment for a genuine hormonal deficiency rather than a shortcut to better energy, confidence, or physical performance.
